White Blood Cell Count and C-Reactive Protein Variations After Posterior Surgery With Intraoperative Radiotherapy for Spinal Metastasis

A nomogram to predict postoperative surgical site infection of adult patients who received orthopaedic surgery: a retrospective study

Surgical site infection is a common postoperative complication with serious consequences. This study developed a nomogram to estimate the probability of postoperative surgical site infection for orthopaedic patients. Adult patients following orthopaedic surgery during hospitalization were included in this study. We used univariate and multivariate logistic regression analyses to establish the predictive model, which was also visualized by nomogram. To evaluate the model performance, we applied the receiver operating characteristic curve, calibration curve, and decision curve analysis, which were utilized in external validation and internal validation. From January 2021 to June 2022, a total of 787 patients were enrolled in this study. After statistical analysis, five variables were enrolled in the predictive model, including age, operation time, diabetes, WBC, and HGB. The mathematical formula has been established as follows: Logit (SSI) = - 6.301 + 1.104 * (Age) + 0.669 * (Operation time) + 2.009 * (Diabetes) + 1.520 * (WBC) - 1.119 * (HGB). The receiver Operating Characteristic curve, calibration curve, and decision curve analysis presented a good performance of this predictive model. Our nomogram showed great discriminative ability, calibration, and clinical practicability in the training set, external validation, and internal validation.

A National Surgical Quality Improvement Program Analysis of Postoperative Major and Minor Complications in Patients with Spinal Metastatic Disease

BACKGROUND

Major complications after spine metastasis surgery are prioritized in the literature with little consideration of the more frequent minor events such as pneumonia or urinary tract infection. We analyzed incidence and risk factors of postsurgical complications in patients with spinal metastasis extracted from the National Surgical Quality Improvement Program (NSQIP). We also developed a useful predictive model to estimate the probability of occurrence of complications.

METHODS

A total of 1176 patients diagnosed with spinal metastasis were extracted from NSQIP. Variables screened included age, sex, tumor location, patient's functional status, comorbidities, laboratory values, and case urgency. Two multivariate logistic regression models were designed to evaluate risk factors and likelihood of event occurrence.

RESULTS

Minor events occurred twice as frequently compared with major complications (36% vs. 18% of patients). The most common major event was death (10%); the most frequent minor event was need for postoperative transfusion (29.4%). In the multivariate analysis, elderly age, emergency case, preoperative leukocytosis, and smoking status retained significance for major complications; American Society of Anesthesiologists classes 4-5, low hematocrit levels, and intradural extramedullary location of the tumor retained significance for minor complications. The predictive models designed explained 72% of the variability in major complications occurrence and 67% for minor events.

CONCLUSIONS

Smoking status and emergent surgery were found to be the strongest independent predictors of major complications, whereas higher American Society of Anesthesiologists class showed a greater association with minor events. The predictive models produced can be a useful aid for surgeons to identify those patients who are at greater risk of developing postoperative adverse events.

The Change of Laboratory Tests Could Be Predictive Factors for Infection after McKeown Esophagogastrectomy

Aim

To analyze whether the change of laboratory tests (postoperative day 1 (POD1) minus pre-operation) could be predictive factors for postoperative infection in patients who have undergone McKeown esophagogastrectomy.

Methods

We retrospectively investigated the clinical data of 358 patients who have undergone McKeown esophagogastrectomy, and divided them into infection and noninfection groups. SPSS 22.0 software was performed for data analysis.

Results

In the two groups, smoking status (66.7% vs. 42.3%; P = 0.014), male gender (86.1% vs. 72.0%; P < 0.001), hoarseness (23.6% vs. 8.7%; P < 0.001), poor coughing ability (51.4% vs. 9.1%; P < 0.001), the change of WBC count (5.59 ± 4.75 × 10⁹/L vs. 4.51 ± 4.11 × 10⁹/L; P = 0.05), the change of glucose (6.03 ± 3.97 g/L vs. 3.78 ± 3.18 g/L), the change of ALB (−12.83 ± 3.45 g/L vs. −10.69 ± 3.86 g/L), the change of CRE (0.17 ± 19.94 umol/L vs. −4.02 ± 15.40 umol/L, P = 0.047) were significantly different. These factors were assessed using logistic regression analysis, and factors with P ≤ 0.05 in the univariate analysis were entered into multivariate analysis based on the forward stepwise (conditional) method. Poor coughing ability (odds ratio [OR], 11.034, 95% confidence interval [CI], 5.358–22.724), smoking status (OR, 4.218; 95% CI, 2.110–8.431), the change of WBC count (OR, 1.079; 95% CI, 1.000–1.164), the change of serum ALB level (OR, 0.849; 95% CI, 0.772–0.935), and the change of blood glucose levels (OR, 1.237; 95% CI, 1.117–1.371) were determined as independent risk factors for postoperative infection. We established a scoring system based on these 5 factors, and the area under the curve for this predictive model was 0.843 (range, 0.793–0.894); the sensitivity, specificity, and cut-off score were 70.8%, 85.3%, and 2.500, respectively.

Conclusion

Poor coughing ability, smoking habit, the high change of WBC and blood glucose levels, and low change of serum ALB levels can be used to predict the occurrence of postoperative infections among patients who have undergone McKeown esophagogastrectomy.